The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review

Sangkum, Lisa; Thamjamrassri, Thanyalak; Arnuntasupakul, Vanlapa; Chalacheewa, Theerawat

doi:10.1155/2021/2156918

Cited by 12 publications

(13 citation statements)

References 161 publications

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“…Managing pain during and after childbirth is a primary concern. 42 However, postoperative pain’s implications go beyond immediate discomfort. Caesarean sections often result in significant postoperative pain, affecting post-recovery, patient satisfaction, breastfeeding, and mother-child bonding.…”

Section: Discussionmentioning

confidence: 99%

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Salazar-Flórez,

Arenas-Cardona,

Marhx

et al. 2024

LRA

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Background Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. Objective To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Methods Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ( ), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Results Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. Conclusion The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.

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Section: Discussionmentioning

confidence: 99%

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Salazar-Flórez,

Arenas-Cardona,

Marhx

et al. 2024

LRA

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“…LSCS results in significant postoperative pain and multimodal analgesia which often includes truncal blocks that are effective to mitigate the severity of pain. [ 2 7 ] To begin with, transversus abdominis plane (TAP) block was used; however, due to poor control over visceral pain, other truncal blocks like QLB and ESPB were incorporated. [ 8 9 10 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia—A randomised study

Bakshi

Srivastawa

Jadon

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims Truncal blocks play an important role in multimodal analgesia regimens to manage the postoperative pain after lower segment caesarean section (LSCS). This study was aimed to compare the analgesic efficacy of ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) and thoracic erector spinae plane block (TESPB) in parturients of LSCS done under subarachnoid block (SAB). Methods In a randomised and double blind study, 60 parturients scheduled for LSCS under spinal anaesthesia were randomly divided into two equal groups group E (n = 30) and group Q (n = 30). After surgery, each parturient received either US guided bilateral TQLB (group Q) or TESPB (group E) with 20 ml 0.375% ropivacaine and 4 mg dexamethasone on each side. Assessments were done at 2, 4, 6, 8, 10, 12 and 24 h. The primary objective was to compare the duration of analgesia (first request to rescue analgesia) and the secondary objectives were to compare pain scores [numerical rating score (NRS)], total amount of tramadol consumption, incidence of nausea-vomiting, parturient satisfaction and other adverse effects in 24 hours postoperatively. Results The duration of analgesia (mean ± standard deviation) was comparable in group E (11.90 ± 2.49 h) and group Q (12.56 ± 3.38 h), P = 0.19. Pain scores (NRS) at rest and on movement were comparable at all time points of 2, 4, 6, 8, 10, 12, and 24 h (P > 0.05). The amount of tramadol used was comparable in group E and group Q (P = 0.48). Conclusion TESPB and TQLB are equally efficacious to provide postoperative analgesia after LSCS done under SAB when used as a part of multimodal analgesia.

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“…NSAIDs are analgesic, antipyretic and anti-inflammatory drugs that inhibit the COX pathway of prostaglandin production [6]. Specifically, prostaglandin E2 and…”

Section: Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Perioperative Analgesia in Caesarean Section: What’s New?

Saucillo-Osuna¹,

Wilson-Manríquez²,

López-Hernández³

et al. 2023

Topics in Postoperative Pain

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Caesarean section is associated with moderate to severe postoperative pain during the first 24 hours after surgery. Inadequate pain management can influence recovery, maternal psychological well-being and breastfeeding. In the search of alternatives to minimize the use of systemic opioids, new recommendations have been made to implement protocols to improve recovery after caesarean section, with multimodal analgesia, new suggestions for neuraxial techniques, regional analgesia with ultrasound-guided fascial plane blocks and non-pharmacological approaches. Some of the interventions, such as epidural or spinal blocks, although effective, carry a significant risk of complications (for example post-puncture headache). In their place, newer alternatives such as interventions guided by ultrasound are safe and effective for relieving pain in this common clinical context. The goal of this chapter is to provide clinicians with up-to-date evidence for optimal pain management after elective caesarean section.

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The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review

Cited by 12 publications

References 161 publications

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Comparison of the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block versus thoracic erector spinae block for postoperative analgesia in caesarean section parturients under spinal anaesthesia—A randomised study

Perioperative Analgesia in Caesarean Section: What’s New?

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